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Non-alcoholic steatohepatitis with normal aminotransferase values

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World Journal of Gastroenterology 2009年第15期15卷 1863-1868页

作者： Hüseyin Saadettin Uslusoy selim giray nak Macit Gülten Zeynep B|y|kl| Department of Gastrenterology Uludag University Medical School Department of Biostatistics Ankara University School of Medicine

AIM： To investigate the aspects of liver histology in patients with non-alcoholic steatohepatitis （NASH） who had normal aminotransferase levels. METHODS： Thirty-four patients diagnosed with liver steatosis by ultrasonographic examination participated in the study. We compared all non- alcoholic fatty liver disease and NASH cases, according to aminotransferase level, aspartate aminotransferase （AST）/alanine aminotransferase （ALT） ratio and presence of metabolic syndrome. RESULTS： Sixteen of 25 patients with high aminotransferase levels were diagnosed with NASH and nine with simple fatty liver according to liver histology. Among the nine patients with normal aminotransferase levels, seven had NASH and two had simple fatty liver. The patients with normal and high liver enzyme levels had almost the same prevalence of NASH and metabolic syndrome. Liver histology did not reveal any difference according to aminotransferase levels and AST/ALT ratio. CONCLUSION： Aminotransferase levels and AST/AIT ratio do not seem to be reliable predictors for NASH. Despite numerous non-invasive biomarkers, all patients with fatty liver should undergo liver biopsy.

关键词： Non-alcoholic steatohepatitis, Liverenzymes Liver histology

Evaluation of leukocyte esterase and nitrite strip tests to detect spontaneous bacterial peritonitis in cirrhotic patients

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World Journal of Gastroenterology 2007年第45期13卷 6027-6030页

作者： Serkan Torun Enver Dolar Yusuf Yilmaz Murat Keskin Murat Kiyici Melda Sinirtas Emre Sarandol selim Gurel selim giray nak Macit Gulten Uludag University Medical School Department of Internal Medicine Bursa 16059 Turkey Uludag University Medical School Department of Gastroenterology Bursa 16059 Turkey Uludag University Medical School Department of Microbiology and Infectious Diseases Bursa 16059 Turkey Uludag University Medical School Departmentof Biochemistry Bursa 16059 Turkey

AIM： To investigate the diagnostic efficacy of leukocyte esterase and nitrite reagent strips for bedside diagnosis of spontaneous bacterial peritonitis （SBP）. METHODS： A total of 63 consecutive patients with cirrhotic ascites （38 male, 25 female） tested between April 2005 and July 2006 were included in the study. Bedside reagent strip testing was performed on ascitic fluid and the results compared to manual cell counting and ascitic fluid culture. SBP was defined as having a polymorphonuclear ascites count of ≥ 250/mm^3. RESULTS： Fifteen samples showed SBP. The sensitivity, specificity, positive and negative predictive values of the leukocyte esterase reagent strips were; 93%, 100%, 100%, and 98%, respectively. The sensitivity, specificity, positive and negative predictive value of the nitrite reagent strips were 13%, 93%, 40%, and 77%, respectively. The combination of leukocyte esterase and nitrite reagents strips did not yield statistically significant effects on diagnostic accuracy. CONCLUSION： Leukocyte esterase reagent strips may provide a rapid, bedside diagnostic test for SBP.

关键词： Spontaneous bacterial peritonitis Urinaryreagent strip Leukocyte esterase Nitrite

Soluble forms of extracellular cytokeratin 18 may differentiate simple steatosis from nonalcoholic steatohepatitis

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World Journal of Gastroenterology 2007年第6期13卷 837-844页

作者： Yusuf Yilmaz Enver Dolar Engin Ulukaya Semra Akgoz Murat Keskin Murat Kiyici Sibel Aker Arzu Yilmaztepe selim Gurel Macit Gulten selim giray nak Uludag University Medical School Department of Internal Medicine Bursa Turkey Uludag University Medical School Department of Gastroenterology Bursa Turkey Uludag University Medical School Department of Biochemistry Bursa Turkey Uludag University Medical School Department of Statistics Bursa Turkey Uludag University Medical School Department of Pathology Bursa Turkey

AIM: To investigate whether serum levels of two soluble forms of extracellular cytokeratin 18 (M30-antigen and M65-antigen) may differentiate nonalcoholic steatohepatitis (NASH) from simple steatosis in patients with nonalcoholic fatty liver disease (NAFLD). METHODS: A total of 83 patients with suspected NAFLD and 49 healthy volunteers were investigated. Patients with suspected NAFLD were classified according to their liver histology into four groups: definitive NASH (n = 45), borderline NASH (n = 24), simple fatty liver (n = 9), and normal tissue (n = 5). Serum levels of caspase-3 generated cytokeratin-18 fragments (M30-antigen) and total cytokeratin-18 (M65-antigen) were determined by ELISA. RESULTS: Levels of M30-antigen and M65-antigen were significantly higher in patients with definitive NASH compared to the other groups. An abnormal value (> 121.60 IU/L) of M30-antigen yielded a 60.0% sensitivity and a 97.4% specificity for the diagnosis of NASH. Sensitivity and specificity of an abnormal M65-antigen level (> 243.82 IU/L) for the diagnosis of NASH were 68.9% and 81.6%, respectively. Among patients with NAFLD, M30-antigen and M65-antigen levels distinguished between advanced fibrosis and early-stage fibrosis with a sensitivity of 64.7% and 70.6%, and a specificity of 77.3% and 71.2%, respectively. CONCLUSION: Serum levels of M30-antigen and M65-antigen may be of clinical usefulness to identify patients with NASH. Further studies are mandatory to better assess the role of these apoptonecrotic biomarkers in NAFLD pathophysiology.

关键词： Steatosis Steatohepatitis Cytokeratin 18 M30-antigen M65-antigen

Noninvasive predictors for liver fibrosis in patients with nonalcoholic steatohepatitis

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World Journal of Hepatology 2011年第8期3卷 219-227页

作者： Hüseyin Saadettin Uslusoy selim giray nak Macit Gülten Department of Gastrenterology zmit Seka State Hospital

AIM:To evaluate certain anthropometric,clinical and laboratory features indicating liver fibrosis in nonalcoholic steatohepatitis and to establish the noninvasive markers for liver ***:Eighty-one patients (40 male,41 female) who were diagnosed with fatty liver by ultrasonographic examination and fulfilled the inclusion criteria participated in the ***,anthropometric,clinical and laboratory features of all cases were recorded and then liver biopsy was performed after obtaining patient ***,necroinflammation and liver fibrosis were examined according to age ≥ 45,gender,body mass index,central obesity,aspartate amino-transferase (AST)/alanine aminotransferase (ALT)>1,γ-glutamyltransferase (GGT)/ALT>1,platelet count,insulin,c-peptide levels and the presence of hypertension,diabetes,hypertriglyceridemia and insulin ***:Eighty-one patients with non-alcoholic steatohepatitis (NASH) enrolled in the study.69 of 81 patients were diagnosed with NASH,11 were diagnosed with simple fatty liver and 1 was diagnosed with ***/ALT>1,GGT/ALT>11,high serum ferritin and fasting insulin levels,the presence of diabetes,hypertension,hypertriglyceridemia and insulin resistance seemed to enhance the severity of steatosis,necroinflammation and fibrosis but these results were not statistically ***:Liver steatosis and fibrosis can occur in individuals with normal *** was no significant concordance between severity of liver histology and the presence of predictors for liver fibrosis including metabolic risk factors.

关键词： Liver fibrosis Predictors Nonalcoholic fatty liver disease Steatohepatitis